MEDICARE: ZACH HENTGES ENTERPRISES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1114732930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZACH HENTGES ENTERPRISES

Provider Business Mailing Address
First Line	:	560 N STAPLEY DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-7320
Country	:	US
Telephone Number	:	480-964-2131
Fax Number	:	480-842-2600

Provider Business Practice Location Address
First Line	:	560 N STAPLEY DR STE 2
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-7320
Country	:	US
Telephone Number	:	480-964-2131
Fax Number	:	480-964-7334

Authorized Official
Title or Position	:	MANAGER/DENTIST
Name	:	ZACHARY HENTGES
Credential	:	DMD
Telephone Number	:	480-313-4143

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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